Role of early postnatal dexamethasone in respiratory distress syndrome

Abstract

Objective: To study the effect of early postnatal dexamethasone therapy on severity of hyaline membrane disease.

Design: Prospective, randomized, controlled, unblinded study.

Setting: Neonatal Intensive Care Unit.

Methods: 19 babies who had hyaline membrane disease were included in this study. The inclusion criteria were clinical and radiographic diagnosis of RDS, requiring mechanical ventilation and FiO2 > 0.3. Ten babies received injection dexamethasone 0.5 mg/kg/dose 12 hourly for 3 days starting within 6 hours of birth. The control group did not receive any drug. Babies with active infection, bleeding tendency and congenital malformation were excluded. None of the babies received surfactant. The duration of ventilation and AaDO2 and FiO2 requirements from day one to five were calculated.

Results: The initial AaDO2 were similar in both the groups but on day 3, 4, 5 AaDO2 were low in study group (201, 85, 70) compared to control group (236, 209, 162). The initial FiO2 were 0.66 and 0.63 in dexamethasone and control groups, respectively and remained high till day 2 and came down in study group on days 3, 4 and 5 (0.41, 0.27, 0.27) compared to control group (0.53, 0.34, 0.42). The mean duration of ventilation was shorter in dexamethasone group (87 hours) vs control group (120 hours).

Conclusion: Early use of postnatal dexamethasone reduces the disease severity and oxygen requirement in RDS and hence would be useful in the Indian context.

PIP: 19 infants with hyaline membrane disease participated in a study to assess the effect of early postnatal dexamethasone therapy upon the severity of their disease. 10 patients received injected dexamethasone of 0.5 mg/kg/dose 12-hourly for 3 days beginning within 6 hours of birth, while the control group received no drug. Infants with active infection, bleeding tendency, and congenital malformation were excluded from the study, and no infant received surfactant. Initial alveolar arterial oxygen gradient (AaDO(2)) levels were similar in both groups, but were lower in the study group at days 3-5. Initial fraction of inspired oxygen (FiO(2)) levels were 0.66 and 0.63 in the dexamethasone and control groups, respectively, and remained high until day 2, then decreased in the study group to levels below those in the control group on days 3-5. The mean duration of ventilation was 87 hours in the dexamethasone group and 120 hours in the control group. These findings indicate that the early use of postnatal dexamethasone reduces the disease severity and oxygen requirement in respiratory distress syndrome, and as such, would be useful in India.